Martina Plag, MHCI, Pn1

When I began the Master of Health Care Innovation (MHCI), it was my midcareer grasp at the edges of my proverbial box—my chance to peer over its confines and envision a reality beyond the well-trodden pathways and procedures of my day-to-day work.

Then the world shifted. COVID-19 swept in like an unforgiving blaze, incinerating the box that both confined and comforted me. And the skills I developed in the program facilitated a metamorphosis from working in the Standardized Patient Program at the University of Pennsylvania’s Perelman School of Medicine to becoming an innovation manager—and now an innovation design strategist—at Penn Medicine’s Center for Health Care Transformation and Innovation.

And yet, as the dust began to settle from the initial shockwave of the pandemic, my newfound role as a crisis-responsive innovator faced an unexpected turn. In professional volunteer organizations I belonged to, my skills flourished without barriers; they were not only valued but celebrated. But in my daily work, the skills that had been applauded and deemed essential during the emergency were now subtly nudged back into the shadows. The message was clear: "Thank you for stepping out of your box—now, if you wouldn't mind, please step back inside."

Once I tasted the exhilaration of design thinking, though, there was no confining myself to old dimensions. The box that once defined my professional identity had been replaced by a vision of what could be—a vision that could not be unseen or ignored.

The date is etched in memory: March 13, 2020. Our routine lives were upended as we packed our desks and traded office keys for uncertainty. Sent home with laptops under our arms and anxiety in our hearts, my colleagues and I faced an invisible foe that reshaped every facet of what we knew about work, collaboration, and community. As we locked up our office for the last time, we had the gut-wrenching task of laying off over 200 temporary workers. The sense of loss was palpable—a vast, collective, unspeakable grief.

And then came a shift: anger turned to action, frustration to fuel.

I am a problem solver—a trained architect, armed with the MHCI’s innovation toolkit. And amid the crisis, I discovered within myself and my colleagues a resiliency previously untapped. In the Standardized Patient Program, we harnessed design thinking principles to navigate this new space. Those affected by layoffs became a driver for developing more inclusive solutions; iterative brainstorming sessions supplanted formal meetings; and rapid prototyping took precedence over perfectionism. Uncertainty demanded that we pivot quickly, fostering a newfound appreciation for diversity in thought and a tolerance for ambiguity. We learned that innovation is about daily practice and that making small changes can lead to significant impacts.

One month after the start of the pandemic, the Standardized Patient Program had stood our empathy exams back on their feet remotely, and Penn’s medical students graduated on time, even as other standardized patient programs across the United States faced widespread shutdowns in response to the health risks posed by COVID-19.

And yet, as the dust began to settle from the initial shockwave of the pandemic, my newfound role as a crisis-responsive innovator faced an unexpected turn. In professional volunteer organizations I belonged to, my skills flourished without barriers; they were not only valued but celebrated. But in my daily work, the skills that had been applauded and deemed essential during the emergency were now subtly nudged back into the shadows. The message was clear: "Thank you for stepping out of your box—now, if you wouldn't mind, please step back inside."

Once I tasted the exhilaration of design thinking, though, there was no confining myself to old dimensions. The box that once defined my professional identity had been replaced by a vision of what could be—a vision that could not be unseen or ignored.

I wasn't looking for a return to normal. Normal had failed us, leaving us unprepared for a crisis of the magnitude we faced. I sought an environment where innovation was not just an emergency lever but a foundational principle, where questioning the status quo was encouraged and creative solutions were part of everyday practice.

So began my quest for belonging—an exploration of opportunities that didn’t just pay lip service to innovation but lived it within their culture. I found a new professional home working first for Way to Health, and now the Center for Insights to Outcomes, both of which are housed in Penn Medicine’s Center for Health Care Transformation and Innovation. 

Four years after the start of the COVID-19 pandemic and the shift to remote work, I reflect on the lessons of Dan Heath's book Upstream, and particularly the concept of problem blindness in health care. Problem blindness is the inability or unwillingness to see a problem that is directly in front of us, which can hinder our capacity for preemptive action. Heath discusses how individuals and organizations get caught up in reactive modes, addressing crises only as they arise rather than preventing them.

The pandemic has highlighted this issue starkly within health care systems. As we adapted to remote work, we were forced to address immediate challenges without adequate attention to the systematic solutions that could have mitigated the crisis’ impact. And now, learning from our collective experience with COVID-19 means embracing upstream thinking to anticipate and prevent problems before they become unavoidable.

In telling yet another COVID tale, I invite you to recognize how crisis can be both destructive and constructive, how it can burn down boxes to build something new, and how it transforms knowledge workers into change makers who are ready to rebuild a world without boxes altogether. Among the ashes of our burned boxes, we can be champions of change. It is up to those of us who understand innovation's potential to educate others—to demonstrate how upstream thinking can prevent problems rather than continually firefighting them.

And to leaders in health care who strive for excellence, I invite you to recognize that innovation is a necessary tool. I invite you to broaden your horizons beyond conventional measures—to create intentional space and time for innovation—and to foster a culture where creativity isn't just welcomed, it’s essential.

Martina Plag is a dedicated innovation manager with over 25 years of experience in design, strategy, and teaching in specialized in health care initiatives. She is adept at launching clinical programs with a focus on patient advocacy and health equity. Her expertise in health care innovation and person-centered solutions is matched by her commitment to using design thinking and interdisciplinary collaboration to enhance patient outcomes through evidence-informed practices.